Provider Demographics
NPI:1841228046
Name:LAZZARIN, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LAZZARIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6085 BIRD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5254
Mailing Address - Country:US
Mailing Address - Phone:305-663-5989
Mailing Address - Fax:
Practice Address - Street 1:6085 BIRD RD STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5254
Practice Address - Country:US
Practice Address - Phone:305-663-5989
Practice Address - Fax:305-663-5689
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36257174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96214Medicare ID - Type Unspecified
FLD27962Medicare UPIN